The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

IMPACT OF 'RESPIRATORY THERAPIST-DRIVEN' ACUTE ASTHMA GUIDELINES IN A PEDIATRIC EMERGENCY DEPARTMENT-A PRELIMINARY REPORT.

Soott Pettinichi, BA, RRT, Steve Smith, RRT, Roy Kulick, MD, MS, Uma Kotagal, MBBS, MSc

Background: As part of a multidisciplinary team, respiratory therapists (RT), who are decentralized to the Emergency Department (ED), assisted in developing acute asthma guidelines. The guidelines included in asthma intake form to gather comprehensive history, a clinical pathway and an asthma flow chart. These guidelines empowered the RT to perform initial respiratory assessment and vital signs, to administer the 1st nebulized treatment (NEB), and to facilitate early steroids. Method: The guidelines were evaluated prospectively on 400 patients (out of 1400 potentially eligible) from 9/96 - 1/97. The study group (SG) was compared to a historical control group (HC) of 563 patients treated in the ED from 3/95-6/95. Results: The asthma flow chart allowed us to estimate severity in the SG (Table 1). Time to the 1st NEB was decreased in the SG (Table 2, p=.001). A higher proportion of the SG received steroids (Table 3, p=.001). Admission rate was 37% in the SG compared to 31% in the HC (p=.046). However, the Admission rate for all 1400 patients seen during the study period was 25%. Experience: Based on these preliminary results, greater RT autonomy in the management of acute asthma may facilitate improved care. We will continue to assess the impact of this program. Conclusion: "RT-driven" acute asthma guidelines resulted in significant process improvements, decrease time to 1st NEB and increase steroid use. We suspect the increased Admission rate in the SG reflects the fact that 72% had moderate to severe exacerbations. However, final assessment of the impact on Admission rate will require further analysis.

STUDY GROUP Severity (TABLE 1)

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TIME TO FIRST NEB (TABLE 2)

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ED STEROID USE (TABLE 3)

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OF-97-059

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